Peptic Ulcer Disease:

General

Lehne pgs 915-928

 Defensive factors (protective): mucus secreted constantly by goblet cells - barrier against pepsis & acid. Bicarb secreted by ipithelial cells in stomach and duodenum. Stays in cucous layer to neutralize H+ in stomach. Secreted by pancreas then into duodenum to neutralize acid. Blood flow needs sufficient flow to maintain mucosal cell integrity. Prostaglandings stimulate secretion of mucous/bicarb; promote vasodilation & suppress gastric acid secretion.

Peptic Ulcer Disease:

Incidence

10% at some time in life. 4.5 mil cases/yr. most commonly in duidenum & lesser curvature of stomach. Most common cause: H. pylori - accts for 60-75% of cases.

Dvlpmt of ulcers depend on balance of defensive and aggressive factors.

Peptic Ulcer Disease:

Aggressive Factors

H.pylori Gm- bacillus, colonizes between epithelial cells & mucosal layer. 1/2 of world has this. Ulcers more common in ppl with h. pylori than those w/o.

 Eradication causes ulcer healing & minimizes recurrence.

NSAIDs prostaglandin inhibition

Gast.acid injures muc. cells→activates pepsin→ proteolytic enzyme, injures cells. Smoking delays healing, increases risk of recurrance.

5 Major Classes of Antiulcer

Drugs

1. antibiotics
2. antisecretory agents
3. mucosal protectants
4. antisecretory agents (enhance mucosal defenses)
5. antacids

Antiulcer Drugs:

Antibiotics

Used to eradicate H.pylori. NIH recommends PID, PUD should receive antibiotics + anti-secretory agents.

MC: amoxicillin, bismuth, clarithromycin, metronidazole, tetracycline - often use combo therapy (2 or 3 antibx) x14 day course.

Antiulcer Drugs:

cimetidine (Tagamet)